Rinaldi P C, Young R F, Albe-Fessard D, Chodakiewitz J
Division of Neurological Surgery, University of California, Irvine.
J Neurosurg. 1991 Mar;74(3):415-21. doi: 10.3171/jns.1991.74.3.0415.
Electrical activity was recorded from single cells in the thalamus of 10 patients with chronic pain associated with deafferentation. Under local anesthesia, these patients underwent either electrode implantation or thalamotomy for treatment of their pain. In eight of the 10 patients, single units were identified as discharging spontaneously in high-frequency, often rhythmic, bursts. The discharges were of two types: short bursts comprised of two to six spikes with a burst frequency of one to four per second; and long trains of 30 to 80 spikes of similar frequency. Reconstruction of electrode trajectories indicated that recordings were made from the region corresponding to the lateral aspect of the mediodorsal thalamic nucleus, the central lateral nucleus, a small part of the central median nucleus, and the parafascicular nucleus. In the eight patients in whom spontaneous neuronal burst activity was exhibited, it was impossible to study activity evoked by natural cutaneous stimulation due to the continuous spontaneous neuronal discharges. Both animal and human studies have suggested that pain related to deafferentation is accompanied by spontaneous hyperactivity in the dorsal horn of the spinal cord and in the ventral posterior thalamic nuclei. The authors present evidence of spontaneous neuronal hyperactivity in the intralaminar thalamic nuclei of patients with pain related to deafferentation. The findings suggest that spontaneous neuronal discharge in patients with pain related to deafferentation is more widespread in the central nervous system than has been previously appreciated. The results have important implications for the surgical treatment of chronic pain.
对10例与去传入相关的慢性疼痛患者的丘脑单细胞电活动进行了记录。在局部麻醉下，这些患者接受了电极植入或丘脑切开术以治疗疼痛。在10例患者中的8例中，单个神经元被确定为以高频、通常有节律的爆发形式自发放电。放电有两种类型：由2至6个尖峰组成的短爆发，爆发频率为每秒1至4次；以及频率相似的30至80个尖峰的长串放电。电极轨迹重建表明，记录是在对应于丘脑背内侧核外侧、中央外侧核、中央中核一小部分和束旁核的区域进行的。在表现出自发性神经元爆发活动的8例患者中，由于持续的自发性神经元放电，无法研究自然皮肤刺激诱发的活动。动物和人体研究均表明，与去传入相关的疼痛伴有脊髓背角和丘脑腹后核的自发性活动亢进。作者提供了与去传入相关疼痛患者丘脑板内核自发性神经元活动亢进的证据。研究结果表明，与去传入相关疼痛患者的自发性神经元放电在中枢神经系统中的分布比以前认为的更为广泛。这些结果对慢性疼痛的手术治疗具有重要意义。
